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BILE DUCT STONES

Bile duct stones or gallstones in the bile duct are also known as choledocholithiasis. It is the presence of a gallstone in the bile duct of the patient. The bile duct is a small tube that carries bile from the gallbladder to the intestine. Gallbladder is a pear-shaped organ that is placed below the liver towards to upper right side of the abdomen. The stones are either present in the gall bladder or in the bile duct that connects the gall bladder and the intestine.

More than 15 percent of the people suffer from gallstones in the bile duct. This condition obstructs the bile duct passage. A person suffering from bile duct stones may undergo severe pain. The person should be immediately taken to the doctor as they may suffer from severe pain and the doctor may give the patient a painkiller for temporary immediate relief>

SIGNS AND SYMPTOMS

The stones present in the bile duct may not cause any symptoms. But once the stones start obstructing the bile duct then the person may experience the following signs and symptoms:

  • Fever
  • Jaundice
  • Pain in the abdomen
  • Nausea
  • Vomiting
  • Loss of appetite
  • Clay colored stool

The pain in the bile duct may be irregular, mild at times and severe at times. When the person suffers from severe pain, immediate medical attention is required. People may sometimes misunderstand the symptoms of bile duct stones with some cardiac problem such as heart attack.

When the gall stone gets stuck in the bile duct, the bile that passes from the gall bladder to the intestine may get infected and spreads to various other parts in the body. If the infection spreads to the liver, it may be life-threatening and may lead to complications like pancreatitis, biliary cirrhosis etc.

CAUSES

There are two types of gallstones. The gall stones that develop due to cholesterol are known as cholesterol gall stones and the gallstones that develop due to pigments are known as pigment gallstones. A person develops cholesterol stones if the bile contains the following.

  • Excess cholesterol
  • Excess bilirubin
  • Inadequate bile salts

The exact cause of the pigment stones is not known but it may develop due to:

  • Infection in the biliary tract
  • Cirrhosis of the liver
  • A hereditary blood disorder that produces excess bilirubin

DIAGNOSIS>

The doctor may first verify the presence of gall stones by the symptoms the patient is experiencing and then he may perform a few tests to diagnose the condition. The tests involved to diagnose choledocholithiasis are:

  • Physical examination is the first thing the doctor performs. The doctor may also ask for the complete medical history of the patient.
  • Transabdominal Ultrasound (TUS) is an imaging procedure that uses high frequency waves to check or examine the internal organs such as liver, spleen, pancreas, kidneys and gallbladder.
  • Endoscopic Retrograde Cholangiography (ERCP) is a procedure that is performed to check for the presence of tumors and stones. It is also helpful to check the width of the bile duct. It may narrow in case of an infection or obstruction in the bile duct.
  • Endoscopic Ultrasound (EUC) uses high frequency sound waves to produce images of the affected part of the intestine or respiratory tract.
  • Abdominal CT Scan is performed to get a clear view of the images of the stomach.
  • Magnetic Resonance Cholangiopancreatography (MRCP) is performed to obtain a MRI of the gallbladder, bile ducts, and pancreatic duct.
  • Percutaneous Transhepatic Cholangiogram (PTCA) is performed to get an X-ray of the bile ducts.

TREATMENT

The following are the treatments to relive the gall stones stuck in the bile duct.

  • Biliary Endoscopic Sphincterotomy (BES) is the most common treatment to extract stone from the bile duct. In this procedure, a balloon type device is inserted into the bile duct to extract the stone.
  • Lithotripsy is a treatment which is designed to fragment the stones so they can be eliminated out of the body easily.
  • Cholecystectomy is performed to remove the entire gallbladder and the stones.
  • Sphincterotomy is a surgical treatment in which the surgeon makes an incision in the bile duct to remove the stones or help them pass out of the body.
  • Biliary Stenting is a procedure which uses tiny tubes to open the passage. This is performed if the patient does not want the gallbladder to be removed.
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